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    <h1>keyose, su registro personal de salud</h1>
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    	<div id="logoDiv">
    		<a href="/record/show/1781" title="Home" accesskey="1"><img src="images/logo.png" alt="keyose, su registro personal de salud" /></a>
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      	<ul>
          <li><a href="/record/logout/" accesskey="9">Cerrar sesión</a></li>
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      </div>   
    </div>

    
		<div id="menuDiv">
      <ul>
        <li><a href="/record/print_card/1781">Ver mi tarjeta</a></li>
        <li><a href="/record/show/1781">Ver mi registro</a></li>
        <li><a href="/records/1781/images">Gestionar mis imágenes</a></li>
        <li><a href="/records/1781/requests">Gestionar mis consultas</a></li>
        <li><a href="/record/tracking/1781">Controlar mi salud</a></li>
        <li><a href="/record/privileges/1781">Cambiar mis permisos</a></li>
        <li><a href="/record/change_password/1781">Cambiar mi contraseña</a></li>
        <li><a href="/record/remove/1781">Eliminar mi registro</a></li>
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      <h2>Modificando los datos de la imagen</h2>



<form action="/records/1781/images/33" class="edit_image" id="edit_image_33" method="post"><div style="margin:0;padding:0"><input name="_method" type="hidden" value="put" /><input name="authenticity_token" type="hidden" value="73ac092f570d274bc0e2e283ed751b09e94ba602" /></div>
<fieldset>
  <div>
    <label>Título</label>
    <input id="image_title" name="image[title]" size="30" type="text" value="none" />
  </div>

  <div class="date">
    <label>Fecha</label>
		<select id="image_generated_at_3i" name="image[generated_at(3i)]">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29" selected="selected">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
<select id="image_generated_at_2i" name="image[generated_at(2i)]">
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6" selected="selected">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
<select id="image_generated_at_1i" name="image[generated_at(1i)]">
<option value="2005">2005</option>
<option value="2006">2006</option>
<option value="2007">2007</option>
<option value="2008">2008</option>
<option value="2009" selected="selected">2009</option>
<option value="2010">2010</option>
<option value="2011">2011</option>
<option value="2012">2012</option>
<option value="2013">2013</option>
<option value="2014">2014</option>
</select>

  </div>

  <div>
    <label>Descripción</label>
    <textarea cols="40" id="image_description" name="image[description]" rows="20"></textarea>
  </div>

  <div>
    <label>Etiquetas</label>
    <input id="image_tags" name="image[tags]" size="30" type="text" value="" />
  </div>
</fieldset>

<div class="buttons">
	<input class="submit" id="image_submit" name="commit" type="submit" value="Guardar" /> o <a href="/records/1781/images">Cancelar</a>
</div>

</form>

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